Fracture of femoral neck in modular total hip arthroplasty: Report of 3 cases and review of the literature.
Keywords:
Modular THA, fracture of the neck, corrosion, revisionAbstract
Modular stems offer to surgeons the flexibility to adjust intraoperatively the femoral neck version independently of individual femoral geometry that theoretically can minimize the bearing surface wear, potential implant loosening and the rate of dislocation. Excellent functional outcomes and survivorship rates of modular stems has been reported in the literature but increasing modularity also renders several postulated disadvantages such as implant fracture, fretting and galvanic corrosion, pseudotumor formation and increased rate of revisions for stem loosening, dislocation and adverse local tissue reactions. We report here three cases of modular femoral neck fractures in patients who underwent a primary total hip arthroplasty in our department and also, we present a systematic review of similar cases in the literature trying to identify the incidence and the main risk factors.
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References
1. Solarino G, Vicenti G, Carrozzo M, Ottaviani G, Moretti B, Zagra L. Modular neck stems in total hip arthroplasty: current concepts. EFORT Open Rev. 2021;6(9):751–758. doi: 10.1302/2058-5241.6.200064.
2. Duwelius PJ, Burkhart B, Carnahan C, Branam G, Ko LM, Wu Y, et al. Modular versus nonmodular neck femoral implants in primary total hip arthroplasty: Which is better? Clin Orthop Relat Res. 2014;472(4):1240–5. doi: 10.1007/s11999-013-3361-4.
3. Omlor GW, Ullrich H, Krahmer K, Jung A, Aldinger G, Aldinger P. A stature-specific concept for uncemented, primary total hip arthroplasty: 10-year results in 155 patients using two stem shapes and modular necks. Acta Orthop. 2010;81(1):126–33.
4. Novoa-Parra CD, Pelayo-de Tomás JM, Gómez-Aparicio S, López-Trabucco RE, Morales-Suárez-Varela M, Rodrigo-Pérez JL. Primary total hip arthroplasty with fourth-generation ceramic bearings: Clinical and survival results with a minimum follow-up of 5 years. Rev Esp Cir Ortop Traumatol. 2019;63(2):110–21. doi: 10.1016/j.recote.2018.07.012.
5. Fitch DA, Ancarani C, Bordini B. Long-term survivorship and complication rate comparison of a cementless modular stem and cementless fixed neck stems for primary total hip replacement. Int Orthop. 2015;39(9):1827–32. doi: 10.1007/s00264-015-2894-4.
6. Lex JR, Welch MD, See A, Edwards TC, Stavropoulos NA, Babis GC. Systematic review of primary total hip arthroplasty using titanium-titanium modular-neck prostheses: the true risk of revision. HIP Int. 2021;31(3):295–303. doi: 10.1177/1120700020916870.
7. Zajc J, Moliˇ A, Fokter SK. Dual Modular Titanium Alloy Femoral Stem Failure Mechanisms and Suggested Clinical Approaches. Materials (Basel). 2021;14(11):3078. doi: 10.3390/ma14113078.
8. Colas S, Allalou A, Poichotte A, Piriou P, Dray-Spira R, Zureik M. Exchangeable Femoral Neck (Dual-Modular) THA Prostheses Have Poorer Survivorship Than Other Designs: A Nationwide Cohort of 324,108 Patients. Clin Orthop Relat Res. 2017;475(8):2046–59. doi: 10.1007/s11999-017-5260-6.
9. Pour AE, Borden R, Murayama T, Groll-Brown M, Blaha JD. High Risk of Failure With Bimodular Femoral Components in THA. Clin Orthop Relat Res. 2016;474(1):146–53. doi: 10.1007/s11999-015-4542-0.
10. Gofton WT, Illical EM, Feibel RJ, Kim PR, Beaulé PE. A Single-Center Experience With a Titanium Modular Neck Total Hip Arthroplasty. J Arthroplasty. 2017;32(8):2450–6. doi: 10.1016/j.arth.2017.03.025.
11. Pelayo-de-Tomás JM, Rodrigo-Pérez JL, Novoa-Parra CD, Lizaur-Utrilla A, Morales-Suárez-Varela M, Blas-Dobón JA. Cementless modular neck stems: are they a safe option in primary total hip arthroplasty? Eur J Orthop Surg Traumatol. 2018;28(3):463–9. doi: 10.1007/s00590-017-2071-0.
12. Kovač S, Mavčič B, Kotnik M, Levašič V, Sirše M, Fokter SK. What factors are associated with neck fracture in one commonly used bimodular THA design? A multicenter, nationwide study in Slovenia. Clin Orthop Relat Res. 2019;477(6):1324–32. doi: 10.1097/CORR.0000000000000646.
13. Vanbiervliet J, Somers JFA. Excellent mid-term results of a new polished tapered modular cemented stem: a study of 113 hip replacements with minimum 5-year follow-up. Hip Int. 2017;27(5):455-459. doi: 10.5301/hipint.5000486.
14. Krishnan H, Krishnan SP, Blunn G, Skinner JA, Hart AJ. Modular neck femoral stems. Bone Jt J. 2013;95 B(8):1011–21. doi: 10.1302/0301-620X.95B8.
15. Lee EW, Kim HT. Early fatigue failures of cemented, forged, cobalt-chromium femoral stems at the neck-shoulder junction. J Arthroplasty. 2001;16(2):236–8. doi:10.1054/arth.2001.20542.
16. Botti TP, Gent J, Martell JM, Manning DW. Trunion fracture of a fully porous-coated femoral stem: Case report. J Arthroplasty. 2005;20(7):943–5. doi: 10.1016/j.arth.2005.06.013.
17. Vučajnk, I; Fokter KS. Modular Femoral Neck Fracture After Primary Total Hip Arthroplasty. J Arthroplasty. 2012;28(1):196.e7-196.e9.
18. Ellman MB, Levine BR. Fracture of the Modular Femoral Neck Component in Total Hip Arthroplasty. J Arthroplasty. 2013;28(1):196.e1-196.e5. doi: 10.1016/j.arth.2011.05.024.
19. Sotereanos NG, Sauber TJ, Tupis TT. Modular Femoral Neck Fracture After Primary Total Hip Arthroplasty. J Arthroplasty. 2013;28(1):196.e7-196.e9. doi: 10.1016/j.arth.2012.03.050.
20. Mencière ML, Amouyel T, Taviaux J, Bayle M, Laterza C, Mertl P. Fracture of the cobalt-chromium modular femoral neck component in total hip arthroplasty. Orthop Traumatol Surg Res. 2014;100(5):565–8. doi: 10.1016/j.otsr.2014.03.027.
21. Baratz MD, Abdeen A. Fracture of a tapered femoral neck after total hip arthroplasty: A case report. JBJS Case Connect. 2014;4(1):1–4. doi: 10.2106/JBJS.CC.M.00155.
22. Hernandez A, Gargallo-Margarit A, Barro V, Gallardo-Calero I, Sallent A. Fracture of the Modular Neck in Total Hip Arthroplasty. Case Rep Orthop. 2015;2015:591509. doi: 10.1155/2015/591509.
23. Trieb K, Stadler N. A New Case of Fracture of a Modular Femoral Neck Device After a Total Hip Arthroplasty. Open Orthop J. 2015;9(1):126–8.
24. Fokter SK, Rudolf R, Moličnik A. Titanium alloy femoral neck fracture-clinical and metallurgical analysis in 6 cases. Acta Orthop. 2016;87(2):197–202. doi: 10.3109/17453674.2015.1047289.
25. Fokter SK, Moličnik A, Kavalar R, Pelicon P, Rudolf R, Gubeljak N. Why do some titanium-alloy total hip arthroplasty modular necks fail? J Mech Behav Biomed Mater. 2017;6:107–14. doi: 10.1016/j.jmbbm.2016.12.012.
26. Ceretti M, Falez F. Modular titanium alloy neck failure in total hip replacement: analysis of a relapse case. SICOT J. 2016;2:20. doi: 10.1051/sicotj/2016009.
27. Skendzel JG, Blaha JD, Urquhart AG. Total Hip Arthroplasty Modular Neck Failure. J Arthroplasty. 2011;26(2):338.e1-338.e4. doi:10.1016/j.arth.2010.03.011.
28. Uchiyama K, Yamamoto T, Moriya M, Fukushima K, Minegishi Y, Takahira N, et al. Early fracture of the modular neck of a MODULUS femoral stem. Arthroplast Today. 2017;3(2):93–8. doi: 10.1016/j.artd.2016.09.004.
29. Murena L, Maritan G, Concina C, Scamacca V, Ratti C, Canton G. Fracture of cobalt-crome modular neck in total hip arthroplasty. Acta Biomed. 2019;90:187–91. doi: 10.23750/abm.v90i12-S.8941.
30. Regis D, Christodoulidis A, Magnan B, Sandri A. Late fracture of an old-generation modular neck in a titanium alloy femoral stem of a cementless total hip arthroplasty. J Clin Orthop Trauma. 2019;10(5):1008–11. doi: 10.1016/j.jcot.2018.06.008.
31. Lanzutti A, Andreatta F, Rossi L, Di Benedetto P, Causero A, Magnan M, et al. Corrosion fatigue failure of a high carbon CoCrMo modular hip prosthesis: Failure analysis and electrochemical study. Eng Fail Anal. 2019;105:856–68. doi: 10.1016/j.engfailanal.2019.07.044.
32. Fokter SK, Gubeljak N, Predan J, Sevšek J, Zajc J, Krajnc Z. Bilateral neck fracture in bimodular femoral stem after primary total hip arthroplasty: a case report. BMC Musculoskelet Disord. 2021;22(1):1–7. doi: 10.1186/s12891-021-04210-y.
33. Wilson DAJ, Dunbar MJ, Amirault JD, Farhat Z. Early failure of a modular femoral neck total hip arthroplasty component: A case report. J Bone Jt Surg. 2010;92(6):1514–7. doi: 10.2106/JBJS.I.01107.
34. Wright G, Sporer S, Urban R, Jacobs J. Fracture of a modular femoral neck after total hip arthroplasty: A case report. J Bone Jt Surg. 2010;92(6):1518–21. doi: 10.2106/JBJS.I.01033.
35. Atwood SA, Patten EW, Bozic KJ, Pruitt LA, Ries MD. Corrosion-induced fracture of a double-modular hip prosthesis: A case report. J Bone Jt Surg. 2010;92(6):1522–5. doi: :10.2106/JBJS.I.00980.
36. Dangles CJ, Altstetter CJ. Failure of the modular neck in a total hip arthroplasty. J Arthroplasty. 2010;25(7):1169.e5-1169.e7. doi: 10.1016/j.arth.2009.07.015.
37. Kohler S, Ratayski H, Zacher J. Implantatbedingte brüche des schenkelhals-konusadapters einer modularen kurzschaft-hüftendoprothese - Patientenmanagement und OP-technik. Z Orthop Unfall. 2011;149(2):185–90.
38. Paliwal M, Gordon Allan D, Filip P. Failure analysis of three uncemented titanium-alloy modular total hip stems. Eng Fail Anal. 2010;17(5):1230–8.
39. Gilbert JL, Mali S, Urban RM, Silverton CD, Jacobs JJ. In vivo oxide-induced stress corrosion cracking of Ti-6Al-4V in a neck-stem modular taper: Emergent behavior in a new mechanism of in vivo corrosion. J Biomed Mater Res - Part B Appl Biomater. 2012;100 B(2):584–94.
40. Pourzal R, Lundberg HJ, Hall DJ, Jacobs JJ. What Factors Drive Taper Corrosion? J Arthroplasty. 2018;33(9):2707-2711. doi: 10.1016/j.arth.2018.03.055.
41. Aspenberg P, Kolmert L, Persson L, Onnerfält R. Fracture of hip prostheses due to inadequate welding. Acta Orthop Scand. 1987;58(5):479–82. doi: 10.3109/17453678709146382.
2. Duwelius PJ, Burkhart B, Carnahan C, Branam G, Ko LM, Wu Y, et al. Modular versus nonmodular neck femoral implants in primary total hip arthroplasty: Which is better? Clin Orthop Relat Res. 2014;472(4):1240–5. doi: 10.1007/s11999-013-3361-4.
3. Omlor GW, Ullrich H, Krahmer K, Jung A, Aldinger G, Aldinger P. A stature-specific concept for uncemented, primary total hip arthroplasty: 10-year results in 155 patients using two stem shapes and modular necks. Acta Orthop. 2010;81(1):126–33.
4. Novoa-Parra CD, Pelayo-de Tomás JM, Gómez-Aparicio S, López-Trabucco RE, Morales-Suárez-Varela M, Rodrigo-Pérez JL. Primary total hip arthroplasty with fourth-generation ceramic bearings: Clinical and survival results with a minimum follow-up of 5 years. Rev Esp Cir Ortop Traumatol. 2019;63(2):110–21. doi: 10.1016/j.recote.2018.07.012.
5. Fitch DA, Ancarani C, Bordini B. Long-term survivorship and complication rate comparison of a cementless modular stem and cementless fixed neck stems for primary total hip replacement. Int Orthop. 2015;39(9):1827–32. doi: 10.1007/s00264-015-2894-4.
6. Lex JR, Welch MD, See A, Edwards TC, Stavropoulos NA, Babis GC. Systematic review of primary total hip arthroplasty using titanium-titanium modular-neck prostheses: the true risk of revision. HIP Int. 2021;31(3):295–303. doi: 10.1177/1120700020916870.
7. Zajc J, Moliˇ A, Fokter SK. Dual Modular Titanium Alloy Femoral Stem Failure Mechanisms and Suggested Clinical Approaches. Materials (Basel). 2021;14(11):3078. doi: 10.3390/ma14113078.
8. Colas S, Allalou A, Poichotte A, Piriou P, Dray-Spira R, Zureik M. Exchangeable Femoral Neck (Dual-Modular) THA Prostheses Have Poorer Survivorship Than Other Designs: A Nationwide Cohort of 324,108 Patients. Clin Orthop Relat Res. 2017;475(8):2046–59. doi: 10.1007/s11999-017-5260-6.
9. Pour AE, Borden R, Murayama T, Groll-Brown M, Blaha JD. High Risk of Failure With Bimodular Femoral Components in THA. Clin Orthop Relat Res. 2016;474(1):146–53. doi: 10.1007/s11999-015-4542-0.
10. Gofton WT, Illical EM, Feibel RJ, Kim PR, Beaulé PE. A Single-Center Experience With a Titanium Modular Neck Total Hip Arthroplasty. J Arthroplasty. 2017;32(8):2450–6. doi: 10.1016/j.arth.2017.03.025.
11. Pelayo-de-Tomás JM, Rodrigo-Pérez JL, Novoa-Parra CD, Lizaur-Utrilla A, Morales-Suárez-Varela M, Blas-Dobón JA. Cementless modular neck stems: are they a safe option in primary total hip arthroplasty? Eur J Orthop Surg Traumatol. 2018;28(3):463–9. doi: 10.1007/s00590-017-2071-0.
12. Kovač S, Mavčič B, Kotnik M, Levašič V, Sirše M, Fokter SK. What factors are associated with neck fracture in one commonly used bimodular THA design? A multicenter, nationwide study in Slovenia. Clin Orthop Relat Res. 2019;477(6):1324–32. doi: 10.1097/CORR.0000000000000646.
13. Vanbiervliet J, Somers JFA. Excellent mid-term results of a new polished tapered modular cemented stem: a study of 113 hip replacements with minimum 5-year follow-up. Hip Int. 2017;27(5):455-459. doi: 10.5301/hipint.5000486.
14. Krishnan H, Krishnan SP, Blunn G, Skinner JA, Hart AJ. Modular neck femoral stems. Bone Jt J. 2013;95 B(8):1011–21. doi: 10.1302/0301-620X.95B8.
15. Lee EW, Kim HT. Early fatigue failures of cemented, forged, cobalt-chromium femoral stems at the neck-shoulder junction. J Arthroplasty. 2001;16(2):236–8. doi:10.1054/arth.2001.20542.
16. Botti TP, Gent J, Martell JM, Manning DW. Trunion fracture of a fully porous-coated femoral stem: Case report. J Arthroplasty. 2005;20(7):943–5. doi: 10.1016/j.arth.2005.06.013.
17. Vučajnk, I; Fokter KS. Modular Femoral Neck Fracture After Primary Total Hip Arthroplasty. J Arthroplasty. 2012;28(1):196.e7-196.e9.
18. Ellman MB, Levine BR. Fracture of the Modular Femoral Neck Component in Total Hip Arthroplasty. J Arthroplasty. 2013;28(1):196.e1-196.e5. doi: 10.1016/j.arth.2011.05.024.
19. Sotereanos NG, Sauber TJ, Tupis TT. Modular Femoral Neck Fracture After Primary Total Hip Arthroplasty. J Arthroplasty. 2013;28(1):196.e7-196.e9. doi: 10.1016/j.arth.2012.03.050.
20. Mencière ML, Amouyel T, Taviaux J, Bayle M, Laterza C, Mertl P. Fracture of the cobalt-chromium modular femoral neck component in total hip arthroplasty. Orthop Traumatol Surg Res. 2014;100(5):565–8. doi: 10.1016/j.otsr.2014.03.027.
21. Baratz MD, Abdeen A. Fracture of a tapered femoral neck after total hip arthroplasty: A case report. JBJS Case Connect. 2014;4(1):1–4. doi: 10.2106/JBJS.CC.M.00155.
22. Hernandez A, Gargallo-Margarit A, Barro V, Gallardo-Calero I, Sallent A. Fracture of the Modular Neck in Total Hip Arthroplasty. Case Rep Orthop. 2015;2015:591509. doi: 10.1155/2015/591509.
23. Trieb K, Stadler N. A New Case of Fracture of a Modular Femoral Neck Device After a Total Hip Arthroplasty. Open Orthop J. 2015;9(1):126–8.
24. Fokter SK, Rudolf R, Moličnik A. Titanium alloy femoral neck fracture-clinical and metallurgical analysis in 6 cases. Acta Orthop. 2016;87(2):197–202. doi: 10.3109/17453674.2015.1047289.
25. Fokter SK, Moličnik A, Kavalar R, Pelicon P, Rudolf R, Gubeljak N. Why do some titanium-alloy total hip arthroplasty modular necks fail? J Mech Behav Biomed Mater. 2017;6:107–14. doi: 10.1016/j.jmbbm.2016.12.012.
26. Ceretti M, Falez F. Modular titanium alloy neck failure in total hip replacement: analysis of a relapse case. SICOT J. 2016;2:20. doi: 10.1051/sicotj/2016009.
27. Skendzel JG, Blaha JD, Urquhart AG. Total Hip Arthroplasty Modular Neck Failure. J Arthroplasty. 2011;26(2):338.e1-338.e4. doi:10.1016/j.arth.2010.03.011.
28. Uchiyama K, Yamamoto T, Moriya M, Fukushima K, Minegishi Y, Takahira N, et al. Early fracture of the modular neck of a MODULUS femoral stem. Arthroplast Today. 2017;3(2):93–8. doi: 10.1016/j.artd.2016.09.004.
29. Murena L, Maritan G, Concina C, Scamacca V, Ratti C, Canton G. Fracture of cobalt-crome modular neck in total hip arthroplasty. Acta Biomed. 2019;90:187–91. doi: 10.23750/abm.v90i12-S.8941.
30. Regis D, Christodoulidis A, Magnan B, Sandri A. Late fracture of an old-generation modular neck in a titanium alloy femoral stem of a cementless total hip arthroplasty. J Clin Orthop Trauma. 2019;10(5):1008–11. doi: 10.1016/j.jcot.2018.06.008.
31. Lanzutti A, Andreatta F, Rossi L, Di Benedetto P, Causero A, Magnan M, et al. Corrosion fatigue failure of a high carbon CoCrMo modular hip prosthesis: Failure analysis and electrochemical study. Eng Fail Anal. 2019;105:856–68. doi: 10.1016/j.engfailanal.2019.07.044.
32. Fokter SK, Gubeljak N, Predan J, Sevšek J, Zajc J, Krajnc Z. Bilateral neck fracture in bimodular femoral stem after primary total hip arthroplasty: a case report. BMC Musculoskelet Disord. 2021;22(1):1–7. doi: 10.1186/s12891-021-04210-y.
33. Wilson DAJ, Dunbar MJ, Amirault JD, Farhat Z. Early failure of a modular femoral neck total hip arthroplasty component: A case report. J Bone Jt Surg. 2010;92(6):1514–7. doi: 10.2106/JBJS.I.01107.
34. Wright G, Sporer S, Urban R, Jacobs J. Fracture of a modular femoral neck after total hip arthroplasty: A case report. J Bone Jt Surg. 2010;92(6):1518–21. doi: 10.2106/JBJS.I.01033.
35. Atwood SA, Patten EW, Bozic KJ, Pruitt LA, Ries MD. Corrosion-induced fracture of a double-modular hip prosthesis: A case report. J Bone Jt Surg. 2010;92(6):1522–5. doi: :10.2106/JBJS.I.00980.
36. Dangles CJ, Altstetter CJ. Failure of the modular neck in a total hip arthroplasty. J Arthroplasty. 2010;25(7):1169.e5-1169.e7. doi: 10.1016/j.arth.2009.07.015.
37. Kohler S, Ratayski H, Zacher J. Implantatbedingte brüche des schenkelhals-konusadapters einer modularen kurzschaft-hüftendoprothese - Patientenmanagement und OP-technik. Z Orthop Unfall. 2011;149(2):185–90.
38. Paliwal M, Gordon Allan D, Filip P. Failure analysis of three uncemented titanium-alloy modular total hip stems. Eng Fail Anal. 2010;17(5):1230–8.
39. Gilbert JL, Mali S, Urban RM, Silverton CD, Jacobs JJ. In vivo oxide-induced stress corrosion cracking of Ti-6Al-4V in a neck-stem modular taper: Emergent behavior in a new mechanism of in vivo corrosion. J Biomed Mater Res - Part B Appl Biomater. 2012;100 B(2):584–94.
40. Pourzal R, Lundberg HJ, Hall DJ, Jacobs JJ. What Factors Drive Taper Corrosion? J Arthroplasty. 2018;33(9):2707-2711. doi: 10.1016/j.arth.2018.03.055.
41. Aspenberg P, Kolmert L, Persson L, Onnerfält R. Fracture of hip prostheses due to inadequate welding. Acta Orthop Scand. 1987;58(5):479–82. doi: 10.3109/17453678709146382.
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